Description:

 As the United States Agency for International Development (USAID) has ceased operations and foreign aid has been dramatically cut, health outcomes in low- and middle-income countries (LMICs) are deteriorating. However, there is less attention given to the impact of the USAID shutdown on intermediaries, specifically non-governmental organizations (NGOs), providing health services in LMICs. How does US foreign aid withdrawal impact NGOs? To examine this question, I leverage the US’s Global Gag Rule (GGR), an historic example of aid withdrawal from sexual and reproductive health (SRH) NGOs who perform or advocate for abortions. Using data from 72 key informant interviews conducted from February 2020 to June 2025 with NGO leaders, physicians, government officials and researchers in Kenya, this paper shows that the 2017 implementation of the GGR impacted not only NGO service delivery, but also their relationships—even among NGOs who never received US funding. Interviews conducted in 2025 (post-USAID shutdown) highlight that the lessons learned from the GGR, particularly how NGOs built coalitions and cooperated in the face of scarcity, provide a model for other community service organizations in LMICs striving to survive current USAID funding cuts.